Individual
DANICE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PRACTITIONER, MED
Contact information
Practice address
3961 FLOYD RD, SUITE 300158, AUSTELL, GA 30106-8535
(678) 785-7284
(770) 438-7929
Mailing address
9814 SPINNAKER ST, CHELTENHAM, MD 20623-1350
(833) 551-7284
(240) 681-3877
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
GA
101YM0800X
Mental Health Counselor
—
MD
101YP1600X
Pastoral Counselor
—
GA
101YP1600X
Pastoral Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
GA
251S00000X
Community/Behavioral Health Agency
Primary
—
MD
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
GA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
MD
Other
Enumeration date
09/23/2014
Last updated
03/25/2026
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